CHILDREN'S Registration Form for VBS 2026

If registering multiple children, please register each child individually!

Child's Preferred Name

Guardian's Name(s)

Relationship to the child being registered:

Parent(s) Grandparent(s) Neighbor(s) Other

Primary Phone Number

Secondary Phone Number (for emergencies)

Primary Email to be used:

This address will receive a confirmation email

Grade During the 2025-2026 School Year

Has this child previously attended VBS at Prairieview?

Yes No

Any known allergies? If yes, please list them and provide any information needed for staff to be able to quickly handle the situation if this child comes in contact with what they are allergic to.

Are there any known behavioral triggers or strategies that you think the staff should be aware of? Please explain. We want to make this experience awesome!

Are there any known emotional or mental health concerns that the staff should be aware of? If so, please provide suggestions for supporting the child.

MEDICAL RELEASE - I, the parent/legal guardian of the child named above, a minor, do here authorize the leadership of Prairieview Covenant Church in New Richmond, WI as agents for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care or service, which is deemed advisable and is to be rendered to said minor, under the general or specific supervision of any physician and surgeon licensed, or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being rendered, and is given as specific consent to any all such diagnosis, treatment, or hospital care which the treating healthcare professional, in the exercise of their best judgment, may deem advisable to protect the life and health of said minor child.

I agree to the medical release described above.

MEDIA RELEASE: Please select one of the options below:

I hereby authorize Prairieview Covenant Church to take and use photographs of my child registered for VBS. I understand that such media will be used for church publications, websites, and social media, and will never be captioned or tagged with their name I DO NOT grant permission for Prairieview Covenant Church to take photos/video of the child I have registered for VBS.

CHILDREN'S Registration Form for VBS 2026

Description

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